Meta-analysis finds mindfulness-based interventions reduce ADHD symptoms in adults, but no better than active psychological controls

According to Dexing Zhang et al., writing in the British Medical Bulletin, “Mindfulness is a moment-by-moment awareness of thoughts, feelings, bodily sensations, and surrounding environment. … These practices can be formal (e.g. breathing, sitting, walking, body scan) or informal (e.g. mindfulness in everyday life).… Mindfulness is rooted in Buddhist traditions. However, it has become popular in recent years among various secular populations in healthcare, educational, and workplace settings: from pre-schoolchildren to older adults across the world.” The two most widely adopted mindfulness-based interventions (MBIs) are mindfulness-based stress reduction and mindfulness-based cognitive therapy (Zhang, 2021).

An Italian research team recently conducted a comprehensive search of the peer-reviewed literature to identify studies exploring the efficacy of mindfulness-based treatments for ADHD. It found 31 studies that qualified for review, ten of which met the criteria for meta-analysis, with a total of 596 participants.

A meta-analysis of seven studies with a combined total of 489 participants found MBIs reduced ADHD symptoms with medium effect size and no sign of publication bias. When split into subgroups with and without active controls – in this case, psychoeducation and skills training groups ­–the outcomes diverged. In the three studies with non-active controls (187 participants), there was a large reduction in ADHD symptoms. In the four with active controls (302 participants), there was no significant difference.

A meta-analysis of ten studies with 596 participants found MBIs reduced inattention symptoms, with a medium-sized effect. Pooling the five studies without active controls (261 participants) produced a very large reduction in inattention symptoms. Once again, in the five studies with active controls (335 participants), there was no significant difference.

After adjusting for publication bias, a third meta-analysis of nine studies with 563 participants found no significant effect of MBIs hyperactivity symptoms. However, when limited to the five studies with-active controls (261 participants), it found a large reduction in hyperactivity symptoms.

After adjusting for publication bias, the fourth meta-analysis of four studies with a combined 243 participants found no significant improvement in executive function.

After adjusting for publication bias, a fifth meta-analysis combining six studies with 449 participants reported a moderate improvement in mindfulness skills. There was no significant improvement when looking only at the three studies with active controls (262 participants).

The team concluded that MBIs seemed to be effective in treating ADHD, but no more so than psychoeducation and skills training groups.

Yet they cautioned that the use of a waiting list for non-active controls muddies that conclusion: “It could be suggested that any intervention seems to have a significantly higher effect than WL [waiting list]in improving ADHD symptoms.” This is a known hazard of using waiting lists as control groups (Cunningham, 2013).

Noting “the low general methodological quality,” they stated, “From a clinical standpoint, according to the poor available evidence, we cannot conclude that MBIs are superior to other active [psychological] interventions in ameliorating all the considered outcomes, suggesting a role complementation and not as a replacement of the psychoeducation in the management of patients with ADHD, consistently with some guidelines’ recommendations.”

Francesco Oliva, Francesca Malandrone, Giulia di Girolamo, Santina Mirabella, Nicoletta Colombi, Sara Carletto, Luca Ostacoli, “The efficacy of mindfulness-based interventions in attention-deficit/hyperactivity disorder beyond core symptoms: A systematic review, meta-analysis, and meta-regression,” Journal of Affective Disorders(2021), vol. 292,475-486, published online,https://doi.org/10.1016/j.jad.2021.05.068.

Dexing Zhang, Eric K P Lee, Eva C W Mak, C Y Ho, and Samuel S Wong, “Mindfulness-based interventions: an overall review,” BritishMedical Bulletin (2021), vol. 138, issue 1, 41-57, published online, https://doi.org/10.1093/bmb/ldab005.

John A Cunningham, KyprosKypri, and Jim McCambridge, “Exploratory randomized controlled trial evaluating the impact of a waiting list control design,” BMC Medical Research Methodology (2013), vol. 13, article 150, published online, https://doi.org/10.1186/1471-2288-13-150.

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